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Gersh, J

Publications and source records attributed to Gersh, J.

SU-F-T-552: A One-Year Evaluation of the QABeamChecker+ for Use with the CyberKnife System

Purpose: By attaching an adapter plate with fiducial markers to the QA BeamChecker+ (Standard Imaging, Inc., Middleton, WI), the output of the CyberKnife can be accurately, efficiently, and consistently evaluated. The adapter plate, known as the Cutting Board, allows for automated alignment of the QABC+ using the CK’s stereoscopic kV image-based treatment localization system (TLS). Described herein is an evaluation of the system following a year of clinical utilization. Methods: Based on a CT scan of the QABC+ and CB, a treatment plan is generated which delivers a beam to each of the 5 plane-parallel ionization chambers. Following absolute calibration of the CK, the QA plan is delivered, and baseline measurements are acquired (and automatically corrected for temperature and pressure). This test was performed at the beginning of each treatment day for a year. A calibration evaluation (using a water-equivalent slab and short thimble chamber) is performed every four weeks, or whenever the QABC+ detects a deviation of more than 1.0%. Results: During baseline evaluation, repeat measurements (n=10) were performed, with an average output of 0.25% with an SD of 0.11%. As a test of the reposition of the QABC+ and CB, ten additional measurements were performed where between each acquisition, the entire system was removed and re-positioned using the TLS. The average output deviation was 0.30% with a SD of 0.13%. During the course of the year, 187 QABC+ measurements and 13 slab-based measurements were performed. The output measurements of the QABC+ correlated well with slab-based measurements (R2=0.909). Conclusion: By using the QABC+ and CB, daily output was evaluated accurately, efficiently, and consistently. From setup to break-down (including analysis), this test required 5 minutes instead of approximately 15 using traditional techniques (collimator-mounted ionization chambers). Additionally, by automatically saving resultant output deviation to a database, trend analysis was simplified. Spectrum Medical Physics, LLC of Greenville, SC has a consulting contract with Standard Imaging of Middleton, WI.

60 APPLIED LIFE SCIENCES↗

TU-FG-201-09: Predicting Accelerator Dysfunction

Purpose: To develop an integrated statistical process control (SPC) framework using digital performance and component data accumulated within the accelerator system that can detect dysfunction prior to unscheduled downtime. Methods: Seven digital accelerators were monitored for twelve to 18 months. The accelerators were operated in a ‘run to failure mode’ with the individual institutions determining when service would be initiated. Institutions were required to submit detailed service reports. Trajectory and text log files resulting from a robust daily VMAT QA delivery were decoded and evaluated using Individual and Moving Range (I/MR) control charts. The SPC evaluation was presented in a customized dashboard interface that allows the user to review 525 monitored parameters (480 MLC parameters). Chart limits were calculated using a hybrid technique that includes the standard SPC 3σ limits and an empirical factor based on the parameter/system specification. The individual (I) grand mean values and control limit ranges of the I/MR charts of all accelerators were compared using statistical (ranked analysis of variance (ANOVA)) and graphical analyses to determine consistency of operating parameters. Results: When an alarm or warning was directly connected to field service, process control charts predicted dysfunction consistently on beam generation related parameters (BGP)– RF Driver Voltage, Gun Grid Voltage, and Forward Power (W); beam uniformity parameters – angle and position steering coil currents; and Gantry position accuracy parameter: cross correlation max-value. Control charts for individual MLC – cross correlation max-value/position detected 50% to 60% of MLCs serviced prior to dysfunction or failure. In general, non-random changes were detected 5 to 80 days prior to a service intervention. The ANOVA comparison of BGP determined that each accelerator parameter operated at a distinct value. Conclusion: The SPC framework shows promise. Long term monitoring coordinated with service will be required to definitively determine the effectiveness of the model. Varian Medical System, Inc. provided funding in support of the research presented.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

TH-AB-201-07: Filmless Treatment Localization QA for the CyberKnife System

Purpose: Accuray recommends daily evaluation of the treatment localization and delivery systems (TLS/TDS) of the CyberKnife. The vendor-provided solution is a Winston-Lutz-type test that evaluates film shadows from an orthogonal beam pair (known as AQA). Since film-based techniques are inherently inefficient and potentially inconsistent and uncertain, this study explores a method which provides a comparable test with greater efficiency, consistency, and certainty. This test uses the QAStereoChecker (QASC, Standard Imaging, Inc., Middleton, WI), a high-resolution flat-panel detector with coupled fiducial markers for automated alignment. Fiducial tracking is used to achieve high translational and rotational position accuracy. Methods: A plan is generated delivering five circular beams, with varying orientation and angular incidence. Several numeric quantities are calculated for each beam: eccentricity, centroid location, area, major-axis length, minor-axis length, and orientation angle. Baseline values were acquired and repeatability of baselines analyzed. Next, errors were induced in the path calibration of the CK, and the test repeated. A correlative study was performed between the induced errors and quantities measured using the QASC. Based on vendor recommendations, this test should be able to detect a TLS/TDS offset of 0.5mm. Results: Centroid shifts correlated well with induced plane-perpendicular offsets (p < 0.01). Induced vertical shifts correlated best with the absolute average deviation of eccentricities (p < 0.05). The values of these metrics which correlated with the threshold of 0.5mm induced deviation were used as individual pass/fail criteria. These were then used to evaluate induced offsets which shifted the CK in all axes (a clinically-realistic offset), with a total offset of 0.5mm. This test provided high and specificity and sensitivity. Conclusion: From setup to analysis, this filmless TLS/TDS test requires 4 minutes, as opposed to 15–20 minutes for film-based methods. The techniques introduced can potentially isolate errors in individual joints of the CK robot. Spectrum Medical Physics, LLC of Greenville, SC has a consulting contract with Standard Imaging of Middleton, WI.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗